Cardiovascular risk prediction in people with chronic kidney disease

Abstract

Purpose of review Clinical guidelines are not consistent regarding whether or how to utilize information on measures of chronic kidney disease (CKD) for predicting the risk of cardiovascular disease (CVD). This review summarizes recent literature regarding CVD prediction in the context of CKD. Recent findings Previous studies used different definitions of CKD measures and CVD outcomes and applied distinct statistical approaches. A recent individual-level meta-analysis from the CKD Prognosis Consortium is of value since it has uniformly investigated creatinine-based estimated glomerular filtration rate (eGFR) and albuminuria as CKD measures and applied the same statistical approach across 24 cohorts with >630,000 participants. In this meta-analysis, eGFR and albuminuria improve CVD risk prediction beyond traditional CVD risk factors, particularly for CVD mortality and heart failure. Albuminuria demonstrates more evident improvement than eGFR. Moreover, several recent studies have shown that other filtration markers, e.g., cystatin C and β2-microglobulin, and measures of atherosclerosis or cardiac damage (e.g., coronary artery calcium and cardiac troponins) can further improve CVD prediction in CKD population. Summary Future clinical guidelines may require updates regarding whether/how to incorporate CKD measures and other biomarkers in CVD prediction, depending on CVD outcomes of interest, target population, and availability of those measures/biomarkers in that population.

Nutrition education in the care of patients with chronic kidney disease and end‐stage renal disease

“…Furthermore, hypertension and diabetes are the 2 leading risk factors for CKD and ESRD; they affect more than 23 million Americans aged 20 or older . CKD has been shown to be strongly and independently associated with cardiovascular disease (CVD), even after adjustment for traditional CVD risk factors . Individuals with CKD experience increased fatal and nonfatal cardiovascular events before and after starting renal replacement therapy .…”

“…10 CKD has been shown to be strongly and independently associated with cardiovascular disease (CVD), even after adjustment for traditional CVD risk factors. [11][12][13][14][15][16][17][18][19] Individuals with CKD experience increased fatal and nonfatal cardiovascular events before and after starting renal replacement therapy. 20 To manage nutrition, CVD risk and minimize risk factors, nutrition counseling about sodium, potassium, phosphorus, and protein intake is recommended.…”

Visceral Adiposity Index and Lipid Accumulation Product Index: Two Alternate Body Indices to Identify Chronic Kidney Disease among the Rural Population in Northeast China

“…Chronic kidney disease (CKD) is a major worldwide public health issue that increases cardiovascular morbidity and mortality [1]. Recently, a high-fat, protein-rich, and high-carbohydrate diet became popular and, along with an improvement in living conditions, has increased the risk of impaired kidney function and CKD [2,3].…”

Troponin Elevation in Chronic Kidney Disease: An Educational Project

“…In summary, the two key measures eGFR and albuminuria improve CVD risk estimates beyond traditional risk factors. It is felt that clinical guidelines may require updates about how or when to integrate CKD measures and other mentioned biomarkers in prediction of CVD based on outcomes desired in a specific population and the accessibility of needed biomarkers in the CKD population Matsushita et al, (2016). Sud & Niamark (2015) conducted a systematic review with the purpose of advancing the understanding of cardiovascular outcomes in patients diagnosed with advanced or progressive CKD.…”